PEPFAR In Crisis: When Funding Fails, Communities Suffer
INSPIRE calls on all partners within the REIPPPP ecosystem remind ourselves that we are part of the communities that we serve.
Authors: Yakhuluntu Dubazana, Shirlane Douglas
We’ve all witnessed it before: the heartbreak of progress halted...
A clinic closes its doors just as it becomes a trusted refuge. A dedicated health worker is laid off just as patients begin to thrive. This February, over 40 PEPFAR-funded implementing partners received termination notices from USAID, drawing a halt to national HIV responses. And the fallout is already evident in many High Burden Districts, areas that overlap significantly with REIPPPP project locations.
For instance, Lejweleputswa in the Free State is host to several Independent Power Producers and simultaneously a PEPFAR target district with high rates of HIV and AIDS. Projects like Wits RHI’s APACE (Accelerating Program Achievements to Control the Epidemic) in Lejweleputswa have been working relentlessly to serve People Living with HIV (PLHIV) and key populations. They’ve supported over 80 adherence clubs, ensured the delivery of antiretroviral therapy (ART) to hard-to-reach rural populations, and maintained psychosocial support services through community mobilisers. Now, these lifelines hang in the balance.
PEPFAR Watch data further highlights the magnitude of the disruption, flagging that clinics in Nelson Mandela Bay, Buffalo City Metro, and Alfred Nzo District have reported suspended operations of filing clerks, data capturers, and linkage officers—effectively dismantling the administrative and human infrastructure that enables efficient chronic medication dispensing and patient follow-up.
In Mangaung, for instance, local mobilisation teams that were once instrumental in reaching adolescent girls and young women with DREAMS interventions have been disbanded. The loss of these services has not only left young people at heightened risk of HIV transmission but has also undermined trust between communities and the healthcare system.
Even where humanitarian exemptions have been announced, services remain disrupted. The 28 January 2025 waiver by US Secretary of State Marco Rubio has not translated into restored access on the ground. Instead, the narrative of “organisational incompetence” sidesteps the real issue—the reckless withdrawal of essential services amidst a global health emergency.
In districts such as Fezile Dabi and Xhariep, PEPFAR-funded programmes were also providing SED linkages—connecting individuals to food parcels, vocational training, and social grants. The removal of these services has left families without basic support systems.
The Real Cost of Withdrawal
When funding disappears, the effects are immediate and visceral. Community health workers are retrenched. Mobile clinics that serve as the only access to care for remote villages are grounded. Drop-in centers for vulnerable adolescents are shut, leaving thousands at greater risk of infection, stigma, and neglect.
These aren’t abstract consequences. They are deeply personal. Picture a 17-year-old girl who no longer has access to pre-exposure prophylaxis (PrEP) because her local clinic’s youth-friendly services were shut down. Or a grandfather who now walks 30 kilometers in vain, hoping to find the ARVs he needs. These are stories of human dignity under threat.
What We Need Now
To save lives, we need rapid and adaptive responses, especially in those areas who need it most, because when funding fails, it’s not just numbers that suffer—it’s people, communities, and futures. The overlap between REIPPPP project areas and PEPFAR High Burden Districts is an opportunity step up and step into action.
